Access Site and Material Selection in Bifurcation Interventions

Dr. Meltem Altınsoy

Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye

ABSTRACT

Radial artery approach has enhance the default alternative for coronary angiography and intervention. Anterior wall micropuncture is the most common method followed by classic double-wall Seldinger technique for suitable radial artery access. locations for the access point is obtained approximately 1 to 2 cm proximal to the styloid process. The most widespread used sheath sizes are 5 or 6 French, but 7 Fr or 8 Fr may often be used in large radial arteries for bifurcation stent placement and other complex coronary interventions. When the radial artery is smaller than 2.8 mm or 8 Fr guidance is required, sheathless guiding catheter techniques are recommended for safer radial use. Femoral artery should be assessed with a combination of palpation, fluoroscopy, and ultrasound to prevent many complications. The artery can be reached using a modified Seldinger technique. The aim of ultrasound usage with the combination of fluoroscopy is to ensure anterior wall puncture and identifying anterior pubis . The iliac artery tortuosity is best guided with a 0.035-inch wire with a steerable soft tip.Transradially or transfemorally access using a 6Fr guiding catheter can be applied in one stent techniques and some complex bifurcation lesions. When more than 2 balloons are simultaneously needed in the guiding catheter, 7Fr or larger catheheter is required. Despite ,most of the interventionalists prefer femoral over radial approach , radial access can be used with sheatless guiding catheter or slender sheaths.If the operator does not plan mini crush,V or simultaneous kissing stenting techniques which are two stents in the guiding catheter,two stent techniques can be applied via 6 Fr guiding catheter. Guide catheters with strong support (such as extra support guide catheters for the left coronary artery and AL 0.75, AL1 or AR2 for the right coronary artery (RCA)) should be chosen for more challenging bifurcations. The ideal wire type might be either hydrophilic or hydrophobic, with or without a polymer coating. It is crucial that the wire’s radiopaque tip does not become lodged in the SB ostium during MV stenting.

Keywords: Radial artery; percutaneous coronary intervention; Femoral artery; Angiography

Referanslar

  1. Romagnoli E, Biondi-Zoccai G, Sciahbasi A, et al. Radi- al versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-El- evation Acute Coronary Syndrome) study. J Am Coll Car- diol. 2012;60(24):2481-2489 [Crossref]
  2. Emmanoil Brilakis. PCI Manual .Minneapolis Heart In- stitute Foundation, Joseph F. And Mary M. Fleischhacker Family Foundation.
  3. Zaragoza, P. F., Domingo, F. P., Viguer, T. C., de Urbina, L. M. O., & Domingo, E. P. Utility of balloon-assisted tracking in radial arterial Access. Age (years), 67(14), 36-91. [Link]
  4. Elangovan, Senthil K., et al. Overcoming Difficult Radial Anatomy During Primary PCI With Balloon-Assisted Track- ing. Cardiac Intervention Today, 2018, 12.1: 46-48. [Link]
  5. Tada N, Takizawa K, Kahata M, Taguri M, Ootomo T, Inoue N. Sheathless guide catheter coronary intervention via radial artery: single-center experience with 9658 procedures. J In- vasive Cardiol. 2015 May;27(5):237-41. [PubMed]
  6. Kwan TW, Cherukuri S, Huang Y, et al. Feasibility and safe- ty of 7F sheathless guiding catheter during transradial coro- nary intervention. Catheter Cardiovasc Interv 2012;80:274-80. [Crossref]  [PubMed]
  7. Jimmy Kerrigan, Timir K Paul, Jay Patel, Walid Saad, An- drew Morse, Elias Haddad , Angel Chandler, Jonathan Em- ling, Hady Lichaa , Vascular Access Management in Com- plex Percutaneous Coronary Interventions, US Cardiology Review 2023;17:e16. [Crossref]  [PubMed]  [PMC]
  8. Seto AH, Abu-Fadel MS, Sparling JM, et al. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial). JACC Cardio- vasc Interv. 2010;3(7):751-758 https://doi.org/10.1016/j. jcin.2010.04.015 [Crossref]  [PubMed]
  9. Elliott M. Groves, Curtiss T. Stinis Coronary Stenting: Prac- tical Considerations, Equipment Selection, Tips and Caveats.In: Eric J. Topol, Paul S. Teirstein. eds. Textbook of Inter- ventional Caridology . 8 th edition.Elsevier 2020.p. 223-234
  10. Louvard Y, Thomas M, Dzavik V, Hildick-Smith D, Galassi AR, Pan M, Burzotta F, Zelizko M, Dudek D,Ludman P, Sheiban I, Lassen JF, Darremont O, Kastrati A, Ludwig J, Iakovou I, Brunel P, Lansky A, Meerkin D, Legrand V, Me- dina A, Lefèvre T. Classification of coronary artery bifurca- tion lesions and treatments:time for a consensus! Catheter Cardiovasc Interv. 2008;71:175-83. [Crossref]  [PubMed]
  11. Kırat T. Fundamentals of percutaneous coronary bifurcation interventions. World J Cardiol. 2022 Mar 26;14(3):108-138. [Crossref]  [PubMed]  [PMC]
  12. Spaziano M, Louvard Y, and Lefèvre T. Treatment of Cor- onary Bifurcation Lesions In: Lanzer P. Textbook of Cath- eter- Based Cardiovascular Interventions. Switzerland: Springer 2018: 745-776 [Crossref]